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A Mystery Unravels

      Why wouldn’t apparent iron-deficiency anemia improve with iron supplementation? That was an enduring question for physicians involved in the care of a 20-year-old woman admitted to the hospital with fever, chest pain and hemoptysis. She had an eventful medical history, beginning at age 8 years when symptoms of anemia and weight loss led to a diagnosis of combined vitamin B12 and folate deficiency. At that time, a small-bowel biopsy demonstrated subtotal villous atrophy and a lymphocytic infiltrate of the small bowel, confirming a diagnosis of celiac disease. She was prescribed vitamin replacement and a gluten-free diet.
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